Experience of heroin overdose among drug users attending general practice.

BACKGROUND: Heroin overdose is responsible for significant mortality. It has not previously been highlighted as an important prevention or care issue for general practitioners (GPs) involved in the management of drug misuse. AIMS: To examine the prevalence and experience of heroin overdose in a population of drug users attending a general practice. METHOD: A questionnaire-based interview of drug users attending a general practice in Dublin, Ireland. RESULTS: Twenty-four (73% of estimated total) drug users were interviewed. Although 17 (71%) were on recognised methadone treatment programmes, 10 (42%) were still injecting heroin. A total of 23 (96%) had witnessed an overdose, with 10 (42%) having been victims of overdose themselves. Twenty-two (92%) knew a victim of fatal overdose, with four (17%) having been present at a fatal overdose. The interviews revealed high levels of activity associated with overdose and poor use of preventive measures. CONCLUSION: The issue of prevention and management of overdose should become a priority for GPs caring for opiate-dependent patients.     

Trends in negative defensive medicine within general practice.

Negative defensive medical practice has adverse consequences both for individual patients and for public health. This paper reports the results from a survey conducted in 1999 in which certain features indicative of negative defensive practice were compared with an identical survey conducted five years previously. Responding general practitioners stated that they are now significantly more likely to undertake diagnostic testing, refer patients, and avoid the treatment of certain conditions.     

Problem drug users known to Bristol general practitioners

A 12-month prospective survey was undertaken of all 239 problem drug users known to general practitioners in Bristol and the doctors' attitudes towards them. The drug users were predominantly young, aged 15-35 years, and males outnumbered females by approximately two to one. Seventy-eight per cent had problems associated with opiates, almost invariably heroin, 10% had problems with stimulants (mainly amphetamine powder), and others had problems with hallucinogens, cannabis, barbiturates and solvents. Opiate dependence was the commonest single problem but ill health, hepatitis, psychiatric illnesses, relationship problems, work and financial difficulties were also frequently mentioned.

There was a wide variation in the numbers of problem drug users seen by individual practices, which related both to the situation of the practice and the widely varying attitudes of the partners towards drug users and drug problems. General practitioners were aware of the grapevine that transmits news of their treatment to other users, and individual practices had typically evolved a general strategy for all drug users, to minimize arguments. General practitioners were asked their views about specialist services: they thought that services in the area for drug users were inadequate to help them and their patients in 58% of cases. Several suggestions were made for additional services which were needed.

     

A controlled evaluation of small-group education of general practitioners in the management of drug users.

We evaluated the effectiveness of small-group education of general practitioners (GPs) in the management of drug users. A total of 40 doctors were trained. Some 28 doctors who were unable to attend and 30 who did not want training participated as comparison groups. Sixteen months after the education, trained doctors notified significantly more drug users to the British Home Office database and more often prescribed methadone at first consultation with a drug user.     

Characteristics of long term benzodiazepine users in general practice

In a practice of 6000 patients, all long term users of day time benzodiazepine tranquillizers were identified and matched for age and sex with controls. Patients and controls were asked to complete two postal questionnaires, one to measure a number of neurotic personality traits and the other to record details of personal history thought to be relevant. Tranquillizer users were also sent a third questionnaire which surveyed their attitudes to reliance on tranquillizers. Long term users of benzodiazepines had significantly higher scores for anxiety and other neurotic traits but their personal histories showed few significant differences from those of controls. Patients reliant on benzodiazepines seem to be a distinct, more `neurotic' sub-group of the practice population although their lives have not been any more disturbed. Most patients thought that tranquillizers had helped them but many felt uneasy about being reliant on them. Follow up showed a trend towards spontaneous discontinuing of the tablets.     

Deaths of heroin users in a general practice population

Recent evidence suggests that heroin users in the UK are 16 times more likely to die than otherwise expected, although causes of death are varied. The present investigation examines deaths of heroin users at a large Scottish general practice over a four-year period prior to 1 July 1985. A mortality rate of 9.72 per 1000 heroin-user patients per year was observed, roughly half that previously reported, although this difference did not prove to be statistically significant. A higher proportion of the observed deaths were attributed to heroin, and fewer to the misuse of other drugs, and it is speculated that this may reflect the practice's policy of not prescribing opiates to heroin users. Factors associated with heroin-user deaths are examined and areas identified where general practitioners may help to avert some of these deaths.     

Improving drug compliance in general practice

Patients of all ages make serious mistakes with their medicines, especially if several are prescribed at once.

Taking medicines involves a great deal of physical and mental work. The best way to help patients take medicines accurately is to reduce this work by packing together all tablets taken at the same time of day. Many elderly patients have relatives who could pack their medicines in this manner.